7.How did you first learn about the HIV Self-Testing? Check all that apply
Local Health Department
GA CAPUS Resource Hub
Other (please specify):
8.How would you describe your gender?
Other gender (specify):
9.What is your ethnicity?
10.What racial group do you consider yourself to be a member of?
More than one race
Native American/Alaskan Native
Native Hawaiian/Pacific Islander
11.Do you have health insurance?
12.Have you ever been tested for HIV?
13.Are you familiar with or have you ever taken Pre-Exposure Prophylaxis (PrEP) for HIV? Check all that apply
I am currently using PrEP.
I have friends who use PrEP.
I have sexual partners who use PrEP.
If my sexual partners take PrEP, I'm at less risk of becoming infected with HIV.
If I take PrEP, I'm at less risk of becoming infected with HIV.
I have never heard of PrEP
PrEP should be used with other HIV prevention measures.
None of these are true.
14.Why do you want a home HIV home self test kit? Check all that apply
Distance from Testing Site
Transportation to Testing Site
Nervous to take a test at a clinic
Use with partner
Observing Social Distancing
Other (Please specify):
15.How would you like to receive your test kit?
Mailed to me
Picked up at local location
15.a How many kits would you like to request?
What is the zipcode or county where you will pick up your test kit?